Impact of HIV infection on aging and immune status

ABSTRACT

Introduction: Thanks to antiretroviral therapy (ART), persons living with HIV (PLWH), have a longer life expectancy. However, immune activation and inflammation remain elevated, even after viral suppression, and contribute to morbidity and mortality in these individuals.

Areas covered: We review aspects related to immune activation and inflammation in PLWH, their consequences, and the potential strategies to reduce immune activation in HIV-infected individuals on ART.

Expert opinion: When addressing a problem, it is necessary to thoroughly understand the topic. This is the main limitation faced when dealing with immune activation and inflammation in PLWH since there is no consensus on the ideal markers to evaluate immune activation or inflammation. To date, the different interventions that have addressed this problem by targeting specific mediators have not been able to significantly reduce immune activation or its consequences. Given that there is currently no curative intervention for HIV infection, more studies are necessary to understand the mechanism underlying immune activation and help to identify potential therapeutic targets that contribute to improving the life expectancy of HIV-infected individuals.

KEYWORDS:

• Aging
• antiretroviral therapy
• comorbidity
• HIV
• immune activation
• inflammation

Article highlights

• PLWH undergo premature aging associated with chronic immune activation and inflammation.

• Compared to seronegative individuals, PLWH have an unexpected increase in non-AIDS events that are typically associated with older age but develop at younger ages.

• Early ART is essential for reducing immune activation and inflammation; however, ART cannot fully control these conditions.

• Because HIV eradication seems impossible at the moment, efforts to understand and control immune activation and inflammation are imperative.

• Therapeutic strategies against immune activation and inflammation include antiretroviral (i.e., earlier initiation of ART) and non-antiretroviral (i.e., modifications of the microbiota) approaches; although at the moment, these have not proven to be useful strategies.

• It seems essential to obtain a consensus about the ideal markers to monitor immune activation and inflammation.

Declaration of interest

JR Blanco has carried out consulting work for Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare; has received compensation for lectures from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare, as well as grants and payments for the development of educational presentations for Gilead Sciences, Bristol-Myers Squibb, Merck and ViiV Healthcare. E Negredo has received research funding, consultancy fees, and lecture sponsorships from and has served on advisory boards for various laboratories (MSD, Abbvie, Boehringer Ingelheim, Gilead Sciences, Viiv Healthcare, Janssen Cilag, and Bristol-Myers-Squibb). J Bernal is founder and shareholder of AlbaJunaTherapeutics, S.L. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.